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- W2891606207 abstract "Background: Improvements in surgical outcomes are predicated on recognizing effective practices with subsequent adaptation. It is unknown whether risk assessment for pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) translates to improved patient outcomes at the practice level. Methods: We originally developed a validated risk model for CR-POPF development following PD (Fistula Risk Score-FRS). A prospectively collected, single-surgeon career experience of 400 consecutive pancreatectomies (2003–2016) was examined. An unaltered duct-to-mucosa pancreatojejunostomy technique was employed for all 269 PDs. Analysis occurred over three eras following the recognized learning curve for PD (i.e. first 50 cases): 1) Development/codification of the FRS (n = 47), 2) reactive, data-driven adjustments of anastomotic stent use (n = 94), and 3) omission of prophylactic octreotide with adoption of selective drainage (n = 78). Observed-to-expected (O/E) rates of CR-POPF were calculated utilizing a multi-institutional derivation set (5,316 PDs). Results: Between Eras 1 and 3, the CR-POPF rate following PD significantly decreased (12.8%–2.6%, p = 0.025), despite increasing fistula risk (median FRS 1 vs. 3; p = 0.021). The risk-adjusted rate declined across the three eras (O/E 1.37→0.96→0.19), as did complication burden (Postoperative Morbidity Index: 0.24→0.24→0.14; p = 0.009). No severe (Grade C) fistulas have occurred over the last 186 cases and resource utilization has been reduced (therapeutic antibiotics: p = 0.008; hospital duration of stay: p = 0.032). In contrast, CR-POPF rates following 131 distal pancreatectomies, for which no validated risk-adjustment process exists, have not changed (≈12%; p = 0.593). Conclusion: Patient outcomes for pancreatoduodenectomy can be optimized by risk-adjusted evaluation and deliberate modification of practice." @default.
- W2891606207 created "2018-09-27" @default.
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- W2891606207 date "2018-03-01" @default.
- W2891606207 modified "2023-10-16" @default.
- W2891606207 title "Quality improvement for pancreatoduodenectomy through the development and integration of procedure-specific risk assessment" @default.
- W2891606207 doi "https://doi.org/10.1016/j.hpb.2018.02.019" @default.
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